Provider Demographics
NPI:1598784720
Name:SOUTHEAST GEORGIA HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:SOUTHEAST GEORGIA HEALTH SYSTEM, INC.
Other - Org Name:SOUTHEAST GEORGIA HEALTH SYSTEM - BRUNSWICK CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MA
Authorized Official - Phone:912-466-7049
Mailing Address - Street 1:2415 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4722
Mailing Address - Country:US
Mailing Address - Phone:912-466-7000
Mailing Address - Fax:912-466-7026
Practice Address - Street 1:2415 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4722
Practice Address - Country:US
Practice Address - Phone:912-466-7000
Practice Address - Fax:912-466-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X
GA063-064282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00000822AMedicaid
GA51000165OtherBLUE CROSS BLUE SHIELD
586000498OtherTRICARE
GA00000822AMedicaid